Gospel Centre Pentecostal Church - Gospel Centre Bible Quiz Team Registration Form 20

First Name

Last Name

Home Number

Mobile Number

Email

First Parent/Guardian's First Name

First Parent/Guardian's Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Second Parent/Guardian's First Name

Second Parent/Guardian's Last Name

Address 1 (If different from above)

Address 2

Country

City

State

Zip/Postal Code

Date of Birth

Alberta Health Card Number

School

Grade

Gender
M
F

Allegries- Any know allergies? Please list them below:

Do you have any special instructions or physical, emotional or behavioral concerns/limitations for this student that we should be aware of?

How did you hear about Bible Quizzing?

Which church do you attend
Gospel Centre
Other________________________________________________
None

Would you like to be involved with our Bible Quiz team in any of the following areas? (Check all you are interested in).
Prayer
Small Group Leader
Set up
Take down
Sanitization

Do we have permission to follow up with your child via text?
Yes
No

INFORMED CONSENT: In the event of an emergency where medical treatment is required, I give permission to the church staff and/or volunteers to obtain services for treatment as deemed necessary if I cannot be contacted in a reasonable amount of time. Further, I will hold harmless or indemnify Gospel Centre Pentecostal Church for any loss or injury that may be sustained. I recognize that there are risks inherent in activities my child may be engaged in and, again, I waive, hold harmless, or indemnify Gospel Centre Pentecostal Church, its instructors, paid or volunteer staff, successors, heirs, and assigns from any action.
Yes
No

Parent/Guardian Signature

Date

WAIVER: I hereby give permission for my child to be photographed and/or filmed without any reimbursement of any kind due to me or the need to pay any fee. Gospel Centre Pentecostal Church considers all information personal and confidential and will only use it within the church for ministry or other church related activities and will not release it to outside parties or organizations.
Yes
No

Parent/Guardian Signature

Date

COVID-19: **READ CAREFULLY BEFORE SIGNING** ALTHOUGH THIS WAIVER IS REQUIRED TO ATTEND, BY SIGNING THIS FORM YOU MAY BE WAIVING CERTAIN LEGAL RIGHTS YOU AND/OR YOUR DEPENDENTS MAY HAVE. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I (and my children) may be exposed to or infected by COVID-19 by attending Gospel Centre Pentecostal Church, and that such exposure or infection may result in personal illness, injury, permanent disability, or death. I understand that if I am 60 years of age or older, or if I am immunocompromised due to medication or an existing health condition or disease, I may be more susceptible to death or serious illness from COVID-19 and am taking increased measures to avoid infection, including wearing a face mask, social distancing or participating in online services. I understand that the risk of becoming exposed to or infected by COVID-19 at Gospel Centre Pentacostal Church may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Gospel Centre Pentecostal Church employees, volunteers, attendees, program participants and their families. I agree while on premises or while participating in off-premises activities events of Gospel Centre Pentecostal Church to abide by all rules and recommendations posted in signs on the premises and otherwise communicated in writing or verbally by Gospel Centre Pentecostal Church, its directors, officers, employees and volunteers, to protect my health and safety, including minors in my care. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any illness or injury to myself (or to my children), including, but not limited to, personal injury, disability, death, damage, loss, claim, liability, or expense, of any kind, that I (or my children) may experience or incur in connection with my (or my children’s) attendance at Gospel Centre Pentecostal Church or participation in its events, programs or activities. On my behalf (and on behalf of my children), I hereby release, covenant not to sue, discharge, and hold harmless Gospel Centre Pentecostal Church, its officers and directors, members, employees, volunteers, agents and representatives, of all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any all liabilities, claims, actions, damages, costs or expenses of any kind based on the actions, omissions, or negligence of Gospel Centre Pentecostal Church, its directors or officers, employees, volunteers, agents and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Gospel Centre Pentecostal Church program or activity.
Yes

Parent/Guardian Signature

Date

Emergency Contact

Emergency Contact Number

Doctors Name

Doctors Number